How common are anxiety disorders in people with autism, and are there effective treatments?

Without question, anxiety is a real and serious problem for many people on the autism spectrum. We hear this from parents, teachers and doctors, as well as from adolescents and adults with autism spectrum disorder (ASD). This disabling anxiety can take the form of one or more disorders, including panic disorder and phobias.

A recent review of scientific studies on autism and anxiety revealed that we have no clear gauge of how commonly anxiety disorders overlap with autism. A few small, relatively short-term studies have produced starkly different results: from 11 percent to 84 percent. (For comparison, the prevalence of anxiety disorders among the general population is about 18 percent.) A reliable estimate will require a study that tracks many more individuals with autism over longer periods of time and that considers the distinctive way that anxiety oftentimes expresses itself in those affected by ASD.

Fortunately, Autism Speaks is funding the Autism Treatment Network, which collects systematic data on a wide range of medical conditions, including anxiety disorders, in children with ASD. This data will help us better understand the proportion of people with ASD who are suffering from anxiety symptoms.

Meanwhile preliminary studies have provided insights. They suggest, for example, that adolescents with autism may be particularly prone to anxiety disorders, while younger children on the spectrum may not differ at all from the average population. Some studies likewise suggest that high-functioning individuals on the spectrum experience higher rates of anxiety disorders than do lower-functioning individuals. Still we must emphasize that these results are preliminary. We don’t know nearly as much as we should about how anxiety disorders affect those with autism.

A recent review of studies found that behavioral interventions can help many children and adolescents with autism who also struggle with anxiety. Along these lines, some studies suggest that cognitive behavioral therapy can be particularly helpful for high-functioning adolescents and adults with autism and anxiety. We will explore behavioral interventions further in a future “Got Questions?” blog. My own expertise is in the medical treatment of anxiety in persons with ASD.

Currently, we have no medications approved by the Food and Drug Administration (FDA) expressly for the treatment of anxiety in children, adolescents or adults with autism. Some classes of drugs commonly prescribed for treating anxiety disorders in the general population likewise help some of those on the autism spectrum. These include the selective serotonin reuptake inhibitors (SSRIs) such as Prozac. For those with autism, anxiety drugs are best used in combination with behavioral interventions. Among high-functioning individuals, they may be particularly effective when combined with cognitive behavioral therapy.

However, some doctors report that anti-anxiety medications seem to be less effective overall in people with autism spectrum disorder than they are in the general population. This observation needs to be verified with controlled research. It suggests the possibility that the biological root of anxiety in those with autism may differ from the “norm” and, as a result, may respond best to different treatments.

At Autism Speaks, we are actively supporting research into anxiety disorders and other medical conditions frequently associated with autism. This includes both basic research on the underlying biology of autism and the safe development of drugs that can relieve disabling symptoms and improve quality of life.

If you are considering anti-anxiety medication for a child with autism, our recently published Medication Decision Aid can help you work with your child’s physician to sort through the pros and cons in the context of your values and goals for your child. You can learn more about the medication tool kit and download a free copy, here.

Got more questions? Send them to GotQuestions@autismspeaks.org. And bring them to our next webchat with Autism Speaks Chief Science Officer Geri Dawson, Ph.D., and Autism Speaks assistant vice president and head of medical research Joe Horrigan, M.D. More information on their monthly webchats here.

Very interesting article! My daughter is 10 years has autism and GAD (General Anxiety Disorder). When she was younger it was hard to separate between the two because they both presented the same depending on the situation. Now as she is a little older and more vocal, I can definitely see a difference. Both are equally frustrating for her and because of her limited communication about her emotions she gets frustrated very easily.

Thank you Autism Speaks for addressing this issue. As a staff person for AS, it is great that you are working on helping families with these problems that are very real for many parents.

My 16 year old son always had anxieties especially around social situations and he always had a hard time dealing with alot of things in life. We were told at age 10 that he had Aspergers, but at age 15 we were told he had social anxiety not Aspergers. I know he has social issues and anxieties could it be Aspergers or just Social anxiety? I’m a confused mom that needs to find a solution for him. He does struggle in school with organization and focus also, he fails in Math. He says he does not get it at all. Thank you maybe you can help me help him.

When is anxiety (or depression) a disorder and when is it a secondary effect of an underlying issue (autism). Environments that are unpredictable, overloaded with sensory stimulation, and unstructured are particularly stress-provoking for individuals with autism. Environments that require a lot of social interaction and inference are also difficult for many. The side effect of this stress may be anxiety and/or depression. Certainly medication may help, but behavioral interventions to improve understanding of dynamic environments, self-management to avoid sensory overload (like when to put on noise dampening headsets), and practices with rote social exchanges can help reduce the stress as well.

Its hard when your teenage son is going through adolesence, anxious about all things just about all the time and not wanting to hang out with kids his own age he never did hang out or play with kids unless they came to him , and even then he would not “play” with them unless they shared the same obsessed interest as him. I thought things were going to improve last year when he was going to join football at his high school, because he loves everything there is about football , but at the last minute he backed out . He did not feel like he could do it,I think he just got to nervous about the whole committed situation.. He also just got his drivers permit, but he keeps putting off practicing driving because he feels the need to watch and play NFL everything. He knows all the players on all the teams, stats, coaches and even the history of the NFL. He has done this all his life about his interests. It gets to a point where he cannot do anything else unless it has to do with whatever hes interested in.He has always been like this. In school he socializes with kids only in class and lunch, but when they want to hang out at home with him he lies to get out of hanging out with them. He says they are friends at school. He has no girlfriends even though I think a girl did like him but we even gave him a cell phone and he never uses it. I was told when he was 10 he had Aspergers, he was in therepy for a few years witch did not seem to change him,but I took him to another Dr. at Kennedy Krieger last year and she spoke with him for about an hour and said he has social anxiety disorder, not Aspergers because if he had Aspergers he would be obsessed with odd things not things like Football, or Cars( when he was very young with the cars) video games too. He is a very disorganized teenager who struggles with math, and comments about how much he hates school. He seems so overwhelmed all the time with school. he seems to just want to go in his own little world of video or NFL and he seems relaxed then . I just don’t know where to start to help him or just leave it be and maybe he’ll blossom like the Kennedy Krieger Doctor said. .She thinks he just needs time and he will blossom . Anyway, Thank you everyone for your help . Any advice for me would be so helpful. I don’t know if this is the right website to comment , but anything will help me to help him. Another issue is that my son thinks hes just fine and he does not have anything wrong with him. Thanks again.

My son is 11 and is high functioning. He has had anxiety for years. He has just recently started on Lexapro and his anxiety seems so much better. He had so much anxiety about everything including school. He would just refuse to go but now after finding out what was scarey about it and talking about it and starting this new med has really helped. He has been working really hard in school and going EVERY day. I hope it stays this way.

Hi
I wonder why nutraceuticals are not further explored for anxiety, instead of drugs.
Dr Ring, what is your opinion on nutraceutics- even when they need further research in terms of safety, dose and long time outcome – especially when they are combined with nutritional approaches?

MLu – yes there are SO many ways to effectively treat anxiety w/out drugs/

1) exercise – ASD kids never get enough- try swimming or adapted P.E, hiking whatever your child likes
2) Get the processed crap out of his diet. Food dyes and sugar cause anxiety, hyperactivity and mood swings.
3) Try GABA, 5-HTP or Selieum before stressful events or at bedtime.
4) Of your child is chronically sick and has severe OCD/ anxiety it could be PANDAS and needs to be treated right away.
5) Go to an Autism Research Institute conference. They have workshops on this issue…

I am a 46 y.o. female on the spectrum (Aspergers) with terrible, debilitating panic attacks and anxiety (I have been diagnosed with Generalized Anxiety Disorder and Panic Disorder also – along with ADHD and Dysthemia.) My doctor currently has me on Xanax three times a day, (and Celexa for mild depression) but I don’t feel that it’s working. I also worry about the long-term effects of being on it, as it seems that everything I hear and read about it refers to having to keep upping the dose over time to make it work. As it is, the stuff makes me so sleepy that I can’t function. I don’t have a full time job right now, though I DO try to do freelance web design from my home whenever I am able to get work, and I need to be awake for that – obviously. I have tried all sorts of “natural” things like herbs, spices, herbal teas, homeopathic options – to no avail.

There are limited options here where I live for adults on the spectrum. (Chattanooga, TN area.) I have yet to find a doctor who specializes in adult autism. I am currently have to use a community mental health clinic (because I have no insurance and inability to pay) and they are trying to treat my anxiety – separate of the autism, of course. I wish that there were more doctors who specialized in autism AND treatments for the other comorbidities as well.

I appreciate this article so much, and the work that you all are doing to try and find out more with regards to this debilitating problem that so many of us have.

It’s good to see an article like this. My son was diagnosed with GAD before he was diagnosed with HF autism (GAD at 8, autism at 13). No one was willing to “label him” or “put him in a box”, but I always knew that it was autism. I believe that his anxiety is sometimes separate and sometimes a result of his autism challenges. He’s been on Prozac since he was 9 and it has helped a lot. Thank you for your research and information!

I think what you’ve mentioned in the post above is quite simple to understand that the a 3 year old child suffering from autism and depression is very challenging. There are times when you feel the child knows what is right but is acting the way he/she is just to have some fun. Then there are really difficult times when we try very hard to make them understand a very simple login but they don’t seem to realize it. I guess the ideas shared by you will help people like us to read into the psyche of little children.

God bless you for working on such studies. Thankfully, my brother’s daughter who is autistic has never suffered from an anxiety attack, I am sure there are many who go through this agony. With such studies emanates consistent data that allows for better techniques and medications. We need to do all we can to further our knowledge related to autism and anxiety.

Hi my name is Ki’ Im eighteen years old and I was recently diagnosed with asd along with anxiety, depression and panic disorders growing up my father knew something was wrong with me but my mom was to proud to notice i needed help. i grew up slower than the other kids i have 2learning disabilitys. i panic about evrythng & am afraid of people. when i turned 18 my dad took me to the dr’s & i was diagnosed i am constantly overwhelmed & just found out my four year niece has autism please help me help her

Hopefully, the continuous progress in biology and medicine will lead us to a better understanding of the relationship between autism and anxiety to develop new medications and help numerous people. Thanks for the informative article.